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Epidemiological Week N00 25 (17 - 23 June 2006) 27 June 06/ Vol. 31/ DEWS 2006-25 Reporting Units...............................................................2 Total number of consultations ........................................2 DEWS Data, Epidemiological Week N0 25 2006............3 DEWS Data, Monthly Summary .....................................5 Acute Diarrhoea..............................................................7 Bloody Diarrhoea............................................................7 Acute Jaundice Syndrome..............................................8 Malaria ............................................................................8 Measles ..........................................................................9 Acute Respiratory Infection ..........................................10 Maternal and Neonatal Health (UNFPA)……………….11 Outbreak Alert and Response ......................................12 Suspected Meningitis ......................................... Measles ……………….…………………………… Acute Flaccid Paralysis ....................................... Number of reported cases and deaths AJK……………13 Number of reported cases and deaths NWFP….……..14 Safe drinking water is still a challenge in EQ areas. In the past month (Epidemiological Two cases of Acute Flaccid weeks 22-25 inclusive), 367,530 Paralysis were reported, from health events under surveillance Battagram district. were reported including 54 deaths. Seven hundred and forty five (745) This week, 217 out of 225 reporting cases of Bloody diarrhoea were units (96%) reported a total of reported; of them, 47% were from 95,352 consultations, including 14 Muzaffarabad, followed by 24% deaths. from Mansehra district. Fifty-four (54) cases of suspected A total of 17,320 ARI cases with 1 measles were reported; 57% (31/54) related death (CFR, 0.005). were under five year old. The Weekly Morbidity and Mortality Report (WMMR) is published by the Ministry of Health of Pakistan (MOH) and the World Health Organization (WHO). The WMMR is built on surveillance data that health service providers and NGOs transmit on a weekly basis from health facilities and hospitals in those areas affected by the earthquake that struck Pakistan on 8 October 2005. The WMMR objectives are to monitor the trend of health conditions over a period of time and provide vital information to all health partners. The WMMR is only a snapshot of the health conditions in those facilities where events are registered and data collected and does not necessarily reflect the situation from other health facilities. The WMMR is a publication that has been developed for emergencies and previously used in other areas such as the Darfur Crisis. The WMMR is published by the World Health Organization (WHO), Health Emergency Operation Centre, House #6, Street #20, F-7/2, Islamabad, Pakistan For More Information, please contact: Dr. Hammam El Sakka, Senior Medical Epidemiologist, WHO/EHA/Pakistan; [email protected] or Dr. Birjees Mazher Kazi, Chief, Public Health Laboratories Division, NIH MOH; [email protected] or WHO Webpage: http://www.whopak.org/disaster WMMR Weekly Morbidity and Mortality Report Pakistan 27 June 2006 / Vol. 31/ DEWS 2006 -25 Reporting Units The total number of reporting sites trained for the Disease Early Warning System (DEWS) in the earthquake affected areas increased by 10 units and total are 225; 217 (96%) sent their surveillance data on time during the epidemiological week 25 (17-23 June 2006). The reporting timeliness of the DEWS system has increased by 3% compared with the previous week (Epidemiological week 24); mainly due to increase of units reported from Muzaffarabad, Poonch, Mansehra and Battagram district, but decrease in Bagh district. As the WHO offices in Balakot and Mansehra were merged, the surveillance data from Balakot was included together with Mansehra district data (Table 1). Table1. Number of reporting heath facilities by district, Earthquake Affected Areas, Pakistan, 27 May-23 June 2006. Reporting Health Facilities Area Population 27May-2Jun 3-9 Jun 10-16 Jun 17-23 Jun Week 22 Week 23 Week 24 Week 25 Muzaffarabad 894,364 25 30 28 35 Bagh 452,532 34 33 35 34 Poonch 633,712 54 53 46 49 Mansehra / Balakot 1,154,804 62 62 61 67 Battagram / Shangla 592,256 29 28 29 31 Islamabad 10,500 1 1 1 1 Total 3,738,168 205 (95%) 207 (96%) 200 (93%) 217 (96%) Total number of consultations The total number of units reported on time increased by 17 this week, over the previous week (from 200 units last week to 217 units this week). Reporting units increased in Muzaffarabad, Poonch, Mansehra and Battagram districts but decrease in Bagh district. The total number of consultations reported throughout DEWS increased by 2% (2,317) compared with the previous week (93,035 to 95,352). The weekly trend of reporting units participating in the DEWS and the number of consultations is shown in Figure 1. No. Unit Reporting Units and Consultations No. Consult. 200000 200 Reporting Unit Consultation 150000 150 100000 100 50 50000 0 0 W42 W43 W44 W45 W46 W47 W48 W49 W50 W51 W52 W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 W22 W23 W24 W25 Week Figure 1. Weekly trend of reporting units and total number of consultations, Earthquake Affected Areas, Pakistan, 15 October 2005 -23 June 2006. 2 WMMR Weekly Morbidity and Mortality Report Pakistan 27 June 2006 / Vol. 31/ DEWS 2006 -25 DEWS Data, Epidemiological Week N0 25 2006 Between 17 - 23 June 2006, 95,352 consultations for health events under surveillance were reported through DEWS. Overall, 19% (17,320) were due to Acute Respiratory Infections (ARI), 12% (11,400) due to Acute Diarrhoea (AWD), 6% (5,825) due to Fever of Unknown Origin (FUO), and 5% (4,744) due to Injuries (INJ). ARI attributed with 26% and 16% in the less than 5 years old and 5 or more years old respectively. AWD was found to be higher in those less than 5 years old and contributed with 19% of the total consultations compared to 10% among 5 years old or more (Figure 2). AWD ARI AWD ARI AWD ARI 10% 16% 12% 19% 19% 26% FUO 6% FUO 6% FUO INJ INJ 6% 5% 5% INJ OTH OTH 5% OTH 58% 44% 63% < 5yrs (n=21,638) ≥ 5yrs (n=73,714) All Ages (n=95,352) Figure 2. Proportion of primary causes for all reported cases, Earthquake Affected Areas, Pakistan, 17-23 June 2006. During this reporting week, 31% (29,175/95,352) of all reportable conditions were reported from Mansehra district, 26% (24,960) reported from Muzaffarabad, followed by 18% (17,513) from Bagh district. Less than 1% of the consultations were reported from H-11 camp in Islamabad, due to decrease in number of IDPs to less than 1,000 populations. The distribution of the total number of consultations by age groups and district is shown in Figure 3. No. Cases Consultations by Age and District (n=95,352) 25000 < 5yrs >= 5yrs 20000 15000 10000 5000 0 MUZ-AJK BAG-AJK POO-AJK MAN-NWFP BAT-NWFP ISLA District / Province Figure 3. The total number of consultations by age and district, Earthquake Affected Areas, Pakistan, 17-23 June 2006. 3 WMMR Weekly Morbidity and Mortality Report Pakistan 27 June 2006 / Vol. 31/ DEWS 2006 -25 DEWS Data, Epidemiological Week N0 25, 2006, 5 years of age and older In the current week, ARI was the most common health event reported among 5 years of age and older, with no related deaths. Twenty-Three (23) clinically diagnosed measles (MES) were reported; of them, 74% (17/23) from Muzaffarabad, 13% (3/23) from Bagh and 9% (2/23) from Battagram district, 1 case from Mansehra district were reported. No measles (MES) cases were reported from Poonch district and H-11 camp Islamabad. One (1) case of Acute Flaccid Paralysis (AFP) was reported from Battagram district. (Figure 4). 12,000 8,000 4,000 0 ARI AWD FUO INJ BD MAL JAU MES AFP TET MEN AHF Cases 11,735 7,390 4,522 3,985 583 572 66 23 1 0 0 0 CFR % 000000000000 Figure 4. Primary causes for the reported cases and weekly CFRs, 5 years of age and older, Earthquake Affected Areas, Pakistan, 17-23 June 2006. DEWS Data, Epidemiological Week N0 25, 2006, less than 5 years In less than 5 year age group, 21,638 consultations were reported; 26% (5,585) of these were attributed to ARI with one (1) related death(CFR% 0.017), while 18% (4,010) were due to acute watery diarrhoea (AWD) with two (2) related death(CFR% 0.049). Thirty-one (31) clinically diagnosed Measles (MES) cases were reported; of them 55% (17/31) from Muzaffarabad, 19% (6/31) from Battagram, 19% (6/31) from Mansehra district, 2 cases (6%) from Poonch district, No cases were reported from Bagh district and from H-11 camp Islamabad. One AFP case reported from Battagram district. 18 cases of suspected Jaundice were reported, out of them 10 cases reported from Muzaffarabad and 5 cases were reported from Mansehra. One case of meningitis (MEN) was reported from Poonch district (Figure 5). 8,000 4,000 0 ARI AWD FUO INJ MAL BD MES JAU AFP MEN AHF TET Cases 5,585 4010 1,303 759 201 162 31 18 1 1 0 0 CFR % 0.017 0.049 0 0 0.497 0 0 0 0 0 0 0 Figure 5. Primary causes for the reported cases and their weekly CFRs, LESS than 5 years old, Earthquake Affected Areas, Pakistan, 17 -23 June 2006. 4 WMMR Weekly Morbidity and Mortality Report Pakistan 27 June 2006 / Vol. 31/ DEWS 2006 -25 DEWS Data, Monthly Summary (Epidemiological Weeks N0 22-25) In summary for the past month between 27 May – 23 June (Epidemiological weeks 22-25 inclusive), a total of 367,530 health events under surveillance were reported, of which 18% (65,552) were due to acute respiratory infection (ARI), 11% (40,471) acute diarrhoea (AWD), 7% (24,083) Unexplained Fever (FUO) and 5% (17,655) Injuries (INJ). Table 2. Comparison of the weekly distribution of reported cases, deaths and monthly Case Fatality Rate (CFR), Earthquake Affected Areas, Pakistan, 27 May - 23Jun 2006.
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